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Healthcare Reform Information

What does health care reform encompass?

The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010.  Most of the laws and regulations target insurance carriers.  However, there are significant parts that effect the consumer directly as well.

How does health care reform affect you individually?

  • Health care will be available for individuals with pre-existing conditions. A person cannot be denied health insurance due to health issues.  Starting in 2014, cancellations and non-renewals based on chronic illness became illegal. This includes both adults and children.
  • Preventative & wellness services, such as diabetes and blood pressure screenings, PSA tests, Pap Smears, Mammograms, etc. will be available at no cost to the consumer.  (Make sure the Doctor codes it as a "wellness visit."
  • Children can remain on their parents’ plan until age 26.
  • An 80/20 rule will force insurance providers to spend at least 80 percent of premium dollars on medical treatment, rather than advertising and executive bonuses. If they do not meet this requirement, they must offer a rebate to customers.
  • Lifetime and annual dollar limits on essential medical treatments are now history, which means that consumers will no longer be denied coverage once their medical expenses reach a certain dollar amount.
  • Health plans are now categorized according to medals:  Platinum, Gold, Silver, Bronze.
  • Depending on a person's income and how many dependents they claim on taxes, a family may be eligible for significant government subsidy to help with monthly insurance premiums.
  • A person or family may no longer purchase health insurance whenever they want.  They must wait until the "Open Enrollment" in order to enroll.  The schedule for this year is as follows:
    • November 1, 2015: Open Enrollment starts — first day one may enroll in a 2016 Marketplace plan.
    • December 15, 2015:  Last day to enroll for a January 1 effective date.
    • January 1, 2016: First date 2016 coverage can start.
    • January 31, 2016: 2016 Open Enrollment ends.
  • The exception to this "Open Enrollment" requirement is if a person loses their health insurance through their job, gets married, divorced, has a baby, etc.  These are called "Qualifying Events" and triggers the ability for a person to obtain health insurance outside of the Open Enrollment period.

How does health care reform affect companies?

  • Beginning January 1, 2016 companies with 50 or more full time employees or 50 "Full Time Equivalents" (FTE) are required to offer health insurance to their employees.  If they do not offer it, the companies face penalties (taxes).
  • Companies must comply with certain mandated regulations.  The health insurance must be determined to provide "Minimum Essential Coverage" (MEC).  See https://www.healthcare.gov/fees-exemptions/plans-that-count-as-coverage/.  It also must be deemed "affordable."  The company may not charge an employee more than 9.5% of the lowest wage earner at the company.  i.e.  If a company employs a minimum wage earner who earns $7.25 per hour, the scenario would play out like this.  $7.25 x 40 hours = $290.00.  $290.00 x 9.5% = $27.55.  So in this scenario, the employer may not charge any employee more than $27.55 per week for health insurance.
  • The health insurance must also meet "Minimum Value."  A health plan meets this standard if it’s designed to pay at least 60% of the total cost of medical services for a standard population, and if its benefits include substantial coverage of inpatient hospital and physician services. Individuals offered job-based coverage that provides minimum value and is considered affordable aren’t eligible for a premium tax credit.  See https://www.healthcare.gov/glossary/minimum-value/.
  • Companies with less than 50 FTE are not required to offer health insurance, but many do in order to attract & retain talent in the workforce.

Logan & Associates can help you select a health care policy to both cover your needs and meet government requirements. Times of drastic change can be confusing. We are here to answer your questions and guide you to a viable solution. Call us to today to get started!

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